Diseases and Conditions Associated with Hepatitis C

by V. J. Smith, RN, BSN, MA
Article Date: 9/1/2004



Hepatitis C is associated with a variety of diseases and
conditions.
This does not mean that HCV causes these conditions, or that they
cause
HCV - it means that these conditions are sometimes found more
frequently in patients who have hepatitis C.

The first section of this article describes some of the various
conditions and illnesses associated with hepatitis C. The second
section
(page 2) lists relevant studies, organized by disease state.

Autoimmune and Inflammatory Disorders

Behcet's Disease
is a rare, chronic inflammatory disorder. Symptoms of
Behcet's disease include recurrent ulcers in the mouth (resembling
canker sores) and on the genitals, and eye inflammation.
The disorder may also cause various types of skin lesions,
arthritis,
bowel inflammation, meningitis (inflammation of the membranes of the
brain and spinal cord), and cranial nerve palsies.
Behcet's is a multi-system disease; it may involve all organs and
affect the central nervous system, causing memory loss and impaired
speech,
balance, and movement.
Cerebral vasculitis is a disorder characterized by inflammation and
necrosis (tissue death) of one or more arteries.
It commonly occurs in the head, especially the temporal arteries
that
branch off of the carotid artery of the neck. The cause is unknown
but
is assumed to be related to an immune response.
Cutaneous vasculitis is a type of inflammation that can affect any
of
the vessels in the skin including capillaries, venules, arterioles
and
lymphatics. Cutaneous vasculitis can be due to any of several
different causes and
can have a wide variety of clinical presentations. It can be acute,
subacute or chronic, and can affect both large and small blood
vessels.
When associated with tissue death, it is described as "necrotizing."
Polyarteritis nodosa is a disease of unknown cause that affects
arteries, the blood vessels which carry oxygenated blood to organs
and
tissues. It occurs when certain immune cells attack the affected
arteries, and
damages the tissues supplied by the affected arteries because they
don't
receive enough oxygen and nourishment without a proper blood supply.
In this disease, symptoms result from damage to affected organs,
often
the skin, heart, kidneys, and nervous system. Generalized symptoms
include fever, fatigue, weakness, loss of appetite, and weight loss.
Muscle aches (myalgia) and joint aches arthralgia) are common. The
skin
may show rashes, swelling, ulcers, and lumps (nodular lesions).
Nerve involvement may cause sensory changes with numbness, pain,
burning, and weakness. Central nervous system involvement may cause
strokes
or seizures. Kidney involvement can produce varying degrees of renal
failure. Involvement of the arteries of the heart may cause a heart
attack
(acute myocardial infarction), heart failure, and inflammation of
the sack
around the heart (pericarditis).
Rheumatoid Arthritis
Rheumatoid arthritis is a chronic (long-term) inflammatory disease
that
primarily affects the joints and surrounding tissues, but can also
affect other organ systems.
Rheumatoid arthritis involves an attack on the body by its own
immune
cells (auto-immune disease). Different cases may have different
causes.
Infectious, genetic, and hormonal factors may play a role.
The disease can occur at any age, but it begins most often between
the
ages of 25 and 55. The disease is more common in older people. Women
are affected more often than men.
Approximately 1-2% of the total population is affected. The course
and
the severity of the illness can vary considerably.
The onset of the disease is usually gradual, with fatigue, morning
stiffness (lasting more than one hour), diffuse muscle aches, loss
of
appetite, and weakness.
Eventually, joint pain appears, with warmth, swelling, tenderness,
and
stiffness of the joint after inactivity. RA usually affects joints
on
both sides of the body equally - wrists, fingers, knees, feet, and
ankles are the most commonly affected.
Sjogren's Syndrome / Sicca Syndrome
Sjogren's syndrome is an autoimmune disorder in which immune cells
attack and destroy the glands that produce tears and saliva.
Sjogren's syndrome is also associated with rheumatic disorders such
as
rheumatoid arthritis. The hallmark symptoms of the disorder are dry
mouth and dry eyes. In addition, Sjogren's syndrome may cause skin,
nose, and vaginal
dryness, and may affect other organs of the body including the
kidneys,
blood vessels, lungs, liver, pancreas, and brain.
Sjogren's syndrome can damage vital organs of the body with symptoms
that may remain stable, worsen, or go into remission. Some people
may experience only the mild
symptoms of dry eyes and mouth, while others go through cycles of
good health followed by severe
disease. Debilitating fatigue and joint pain can seriously impair
quality
of life. Many patients are able to treat problems symptomatically.
Others are
forced to cope with blurred vision, constant eye discomfort,
recurrent
mouth infections, swollen parotid glands, hoarseness, and difficulty
in
swallowing and eating. The term "sicca" refers to the dryness of the
eyes and mouth.
Systemic Lupus Erythematosus
In systemic lupus erythematosus (SLE) and other autoimmune diseases,
the body's defenses against infection are turned against the body
and
rogue immune cells attack tissues.
Antibodies may be produced that can react against the body's blood
cells, organs, and tissues. These lead immune cells to attack the
affected
systems, producing chronic disease.
The mechanism or cause of autoimmune diseases is not fully known,
but
many researchers suspect it occurs following infection with an
organism
that looks similar to particular proteins in the body, which are
later
mistaken for the organism and wrongly targeted for attack.
The course of the disease may vary from a mild episodic illness to a
severe fatal disease. Symptoms also vary widely in a particular
individual over time and are characterized by periods of remission
and
exacerbation.
At its onset, only one organ system may be involved. Additional
organs
may become involved later.

Blood and Circulatory Disorders
Agranulocytosis
is a condition in which there is an insufficient number
of white blood cells called neutrophils or granulocytes.
This can be caused by a failure of the bone marrow to make
sufficient
neutrophils or when white blood cells are destroyed faster than they
can
be produced. Affected people are susceptible to infections.
Antiphospholipid-antibody syndrome is a rare immune system
characterized by the presence of certain abnormal proteins in the
blood.
Antiphospholipid antibodies interfere with the normal function of
blood vessels.
Certain infections and medications can result in the production of
these proteins, which can increase the risk of blood clots.
Antiphospholipid-antibody syndrome can be associated with blood
clots
in the legs and lungs, migraines, miscarriages, strokes and other
blood
disorders.

Aplastic Anemia Secondary aplastic anemia results from injury to
stem cells. Normal
stem cells divide and differentiate into all blood cell types.
Thus, when stem cells are injured, there is a reduction in red blood
cells, white blood cells, and platelets. This condition can be
caused by chemotherapy, drug therapy to suppress
the immune system, radiation therapy, toxins such as benzene or
arsenic, drugs, pregnancy, and congenital disorders.
Immunohemolytic (Coombs-positive) Anemia
Hemolytic anemia is a term used for a variety of anemias
characterized
by a low count of red blood cells. Hemolytic anemia occurs when red
blood cells are destroyed faster than bone marrow can produce them.
The term for destruction of red blood cells is "hemolysis."
Immunohemolytic (coombs-positive) anemia is the destruction of red
blood cells due to an inappropriate attack on the red blood cells by
cells
of the immune system.
Caput medusae are dilated veins seen on the lower abdomen of
patients
with cirrhosis of the liver. Cirrhosis impairs blood flow through
the liver, causing increased
pressure in the portal system (portal hypertension). The increased
blood
pressure can be transmitted to collateral veins in the abdomen,
causing
the formation of visible varicose veins in the lower abdomen.
CryoglobulinemiaThe symptoms associated with cryoglobulinemia occur
when the
cryoglobins are exposed to cold temperatures and precipitate, or
clump together.
The precipitated immunoglubulins are large enough to block off small
arteries and capillaries in the extremities.
The presence of the cryoglobin clusters can act as a direct irritant
on
the lining of arteries and veins, causing an inflammation of blood
vessels called vasculitis. In cryoglobulinemia associated with HCV
infection, the vasculitis
typically involves the smaller blood vessels of the skin, kidneys,
and
gastrointestinal tract. For references, see the article
Cryoglobulinemia and Hepatitis C
Infection.
Hyperlipasemia
Lipase is an enzyme, secreted by the pancreas and small intestine
that
breaks down fats into glycerol and fatty acids during digestion.
Hyperlipasemia is a condition in which the level of lipase in the
blood
is higher than normal. Greater-than-normal levels suggest
pancreatitis, pancreatic
cancer or cholecystitis.
Idiopathic Thrombocytopenic Purpura (See Skin Disorders)
Porphyria Cutanea Tarda
Porphyria is a group of at least eight diseases caused by
abnormalities
in the chemical steps that lead to heme production.
Found mostly in the blood, bone marrow, and liver, heme is a vital
molecule for all of the body's organs. Heme is a component of
hemoglobin, the molecule
that carries oxygen in the blood. Porphyria cutanea tarda is the
most common type of
porphyria.
Signs and symptoms usually begin in adulthood and result from the
skin
becoming overly sensitive to sunlight.
Areas of skin exposed to the sun develop severe blistering,
scarring,
changes in pigmentation; increased hair growth and is easily
damaged.
People with porphyria cutanea tarda also have increased iron levels
in
the liver. They face a higher risk of developing abnormal liver
function and liver cancer. The signs and symptoms of this condition
are triggered by
nongenetic factors such as alcohol abuse, excess iron, certain
hormones, and viral
infections.
Raynaud's Syndrome
Raynaud's phenomenon is a disorder that affects the blood vessels in
the fingers, toes, ears, and nose. This disorder is characterized by
episodic attacks,
called vasospastic attacks that cause the blood vessels in the
digits (fingers and toes)
to constrict (narrow). Raynaud's phenomenon can occur on its own, or
it can be secondary to
another condition such as scleroderma or lupus. An attack is usually
triggered by exposure to
lips, or ear lobes.
Spider Nevi (Spider Angioma)
Spider angioma is an abnormal collection of blood vessels near the
surface of the skin. The appearance is often similar to that of a
small
spider web. A spider angioma lesion typically has a red dot in the
center with
reddish extensions radiating out for some distance around it (a few
millimeters to a centimeter or more). Spider angiomas can occur
anywhere but are most
common on the face and trunk, and are very common during pregnancy
and in patients with liver disease.
A colloquial term for spider nevi is "gin blossom."
Thrombocytopenia is a disorder in which the number of platelets (a
type
of blood cell) is abnormally low, sometimes associated with abnormal
bleeding. Platelets are cells in the blood that help blood to clot.
Thrombocytopenia refers to any disorder in which there are not
enough platelets.
Thrombocytopenia can also be associated with cancers of the blood
and
with disorders that cause bone marrow dysfunction.
Symptoms can include bruising, nosebleeds or oral bleeding, and
petechial rash (pinpoint red spots).
Other symptoms may be present as well, depending on the cause of the
condition. Mild thrombocytopenia can occur without symptoms.

Cardiac Disorders
Hypertrophic cardiomyopathy (HCM) is a form of cardiomyopathy
(disease
of the heart muscle) involving enlargement and thickening of the
heart
muscle. The thickening is often not symmetrical, affecting one part
of the
heart more than others. It may interfere with the functioning of the
heart
by reducing the size of the ventricular chamber.
It may also reduce the ability of the valves to work properly. The
enlargement may, in some circumstances, obstruct the flow of blood
out of the heart.

Cancers
B-cell Lymphoma
Burkitt (b-cell) lymphoma is a lymph gland tumor classified as a
non-Hodgkin's type of lymphoma. Lymphoma is a malignancy (cancer) of
lymph
tissue found in the lymph nodes, spleen, liver, and bone marrow.
The first sign of this cancer is often an enlarged lymph node which
appears without a known cause. The disease can spread to adjacent
lymph nodes
and later may spread outside the lymph nodes to the lungs, liver,
or bone marrow.
Cholangiocarcinoma is a malignant (cancerous) growth in one of the
ducts that carries bile from the liver to the small intestine.
A cholangiocarcinoma can arise anywhere along the liver secretion
(biliary) ducts. These tumors produce symptoms by blocking the bile
ducts.
They affect both sexes, and a majority of cases are found in
patients
above the age of 65.
Head and Neck Squamous-Cell Carcinoma
Squamous cell carcinoma (cancer) is a malignant tumor that affects
the
middle layer of the skin. It is more aggressive than basal cell
cancer, but still may be
relatively slow-growing. It is more likely than basal cell cancer to
spread
(metastasize) to other locations, including internal organs.
In the context of hepatitis C infection, squamous cell carcinoma may
be
consequence of the development of lichen planus.
Hepatocellular Carcinoma
Liver cancer, also called hepatocellular carcinoma or malignant
hepatoma, is a primary liver cancer that originates in the
hepatocytes (liver
cells). Hepatocellular carcinoma is a tumor that is relatively
uncommon in the
United States, although its incidence is rising, principally in
relation to the spread of hepatitis C infection. When liver cancer
metastasizes, the cancer
cells tend to spread to nearby lymph nodes and to the bones and
lungs.
Multiple myeloma is a cancer of the plasma cells in bone marrow,
characterized by the excessive growth and malfunction of plasma
cells in the
bone marrow. The growth of these extra plasma cells interferes with
the production
of red blood cells, white blood cells, and platelets. This cause
anemia, susceptibility to infection, and increased tendencies toward
bleeding. As the cancer cells grow and expand in the bone marrow,
they also cause
pain and destruction of the bones. If the bones in the spine are
affected, compression
of the nerves may result causing numbness or paralysis.
Non-Hodgkin's Lymphoma
Non-Hodgkin's lymphomas are cancers of lymphoid tissue (lymph nodes,
spleen, and other organs of the immune system). Non-Hodgkin's
lymphomas can be slow-growing
("low-grade") or rapidly growing ("high-grade") cancer.
For most patients, the cause is unknown, but lymphomas can develop
in
people with a suppressed immune system, such as after organ
transplantation.

Digestive and Biliary System Disorders Biliary Cirrhosis
Primary biliary cirrhosis is a liver disease that slowly destroys
the
bile ducts in the liver. Bile is a substance that helps digest fat,
is produced in the liver,
and leaves the liver through these ducts. When the ducts are
damaged, bile builds up in the
liver and damages liver tissue, causing cirrhosis.
Celiac Disease (Sprue)
Celiac disease is an inherited, autoimmune disease.
The lining of the small intestine is damaged in response to
ingestion
of gluten and other proteins found in wheat, barley, rye, possibly
oats,
and their derivatives. The exact cause of celiac disease is
unknown. The symptoms of celiac
disease can vary significantly from person to person.
A partial listing of symptoms includes abdominal pain, abdominal
distention, bloating, gas, indigestion, constipation, decreased
appetite,
diarrhea, lactose intolerance, nausea and vomiting, stools that
float, are
foul smelling, bloody, or "fatty," and unexplained weight loss.
Esophageal Varices
Varices are veins which have been stretched and distorted by the
increased pressure of blood diverted form the portal vein.
Although esophageal varices are often discussed as a complication of
liver disease, varices can also develop in the stomach and rectum.
Any cause of chronic liver disease can cause bleeding varices.
Varices
are thin-walled and under high blood pressure and bleeding is a
common
problem.
Hemosiderosis / Hemochromatosis (Iron Storage Disease)
Hemosiderosis is the presence of increased amounts of iron in
tissues
("iron-rich foci"). When the surplus iron deposition is associated
with tissue injury, the
disease state is called hemochromatosis.Hemochromatosis is the most
common form of iron
overload disease, in which the body absorbs and stores too much
iron.
The extra iron builds up in organs and damages them. Without
treatment,
the disease can cause these organs to fail.
Joint pain is the most common complaint of people with
hemochromatosis.
Other common symptoms include fatigue, lack of energy, abdominal
pain,
loss of sex drive, and heart problems.
Pancreatitis
Pancreatitis is an inflammation or infection of the pancreas, an
elongated, tapered gland located behind the stomach.
The pancreas secretes digestive enzymes and the hormones insulin and
glucagon. The various types of pancreatitis involve irritation,
inflammation, and
infection of the pancreas. The disorders differ according to whether
symptoms develop suddenly or slowly. Specific types of pancreatitis
are chronic pancreatitis,
acute pancreatitis and pancreatic abscess.
Spontaneous Bacterial Peritonitis
Peritonitis is an inflammation of the peritoneum, which is the
membrane
that lines the wall of the abdomen and covers the organs.
Spontaneous peritonitis is an infection that occurs as a
complication
of ascites (a collection of fluid in the peritoneal cavity), which
is
usually related to liver or kidney failure.
Most cases of bacterial peritonitis occur either when fluid
accumulates
in the peritoneal cavity (ascites) because of chronic liver disease,
or
in kidney failure patients undergoing peritoneal dialysis.
Risk factors for liver disease include alcoholic cirrhosis and other
diseases that lead to cirrhosis, such as viral hepatitis.

Kidney Disorders
Glomerulonephritis is a type of kidney disease caused by
inflammation
of the internal kidney structures (glomeruli). Glomerulonephritis
may be a temporary and
reversible condition, or it may be progressive.
Progressive glomerulonephritis may result in destruction of the
kidney
glomeruli and chronic renal failure and end stage renal disease.
The disease may be caused by specific problems with the body's
immune
system, but the precise cause of most cases is unknown.
Damage to the glomeruli with subsequent impaired filtering causes
blood
and protein to be lost in the urine. Because symptoms develop
gradually, the disorder may be discovered when
there is an abnormal urinalysis during routine physical or
examination
for unrelated disorders. Glomerulonephritis can cause hypertension
and may only be discovered as
a cause of hypertension that is difficult to control.
Membranoproliferative Glomerulonephritis
is a form of glomerulonephritis caused by an abnormal immune
response, with deposits of antibodies in
the internal kidney structures (glomeruli). The glomerular membrane
disruption causes a change in urine filtration,
making the glomerulus permeable to protein and blood cells.
This is manifested as acute nephritic syndrome, nephrotic syndrome,
or
abnormal urinalysis without symptoms. Urine output decreases
because
of reduced glomerular filtration rate. Swelling may occur as sodium
and water are retained in the body.
Protein in the bloodstream keeps fluid within the blood vessels.
Edema
is increased when protein is lost because fluid leaks out of blood
vessels into the tissues. Hypertension occurs due to the cumulative
effects of water and sodium
retention and increased production of renin (a hormone that
regulates
blood pressure) by the damaged kidney. Nitrogenous waste products
such as urea (BUN)
and creatinine may accumulate in the blood (azotemia) because of
poor kidney functioning. The
disorder is often progressive and eventually results in chronic
renal
failure.
Hepatorenal Syndrome
Hepatorenal syndrome occurs when there is a decrease in kidney
function
in a person with a liver disorder. The most common symptom is
decreased urine production. As a result of
reduced elimination of urine, nitrogen-containing waste products
accumulate in the blood stream (azotemia).
The exact cause of hepatorenal syndrome is unknown. For some reason,
there is drastic reduction in blood flow to the kidneys.
The kidney structure remains essentially normal and the kidneys
often
will instantly function well if the liver disease is corrected (for
example, by liver transplantation). The disorder occurs in up to 10%
of patients hospitalized with liver
failure. It may be a sign of impending death caused by the
accumulated effects
of liver damage and kidney failure in people with acute liver
failure,
cirrhosis or alcoholic hepatitis. It is diagnosed when other causes
of kidney failure are ruled out.

Lung Disorders
Pulmonary Fibrosis involves scarring or thickening of tissues deep
in
the lung without a known cause. Pulmonary fibrosis damages the air
sacs (alveoli) and leads to reduced
transfer of oxygen to the blood, resulting in shortness of breath on
exertion, decreased tolerance for activity, cough (usually dry), and
chest pain. When the cause of pulmonary fibrosis is unknown, the
disease is
described as idiopathic.

Metabolic and Hormonal Disorders
Diabetes is a life-long disease marked by high levels of sugar in
the
blood. It can be caused by too little insulin (a hormone produced by
the
pancreas to regulate blood sugar), resistance to insulin, or both.
In Type 1 diabetes, the body makes little or no insulin, and daily
injections of insulin are required to sustain life.
In Type 2 diabetes, the pancreas does not make enough insulin to
keep
blood glucose levels normal, often because the body does not respond
well to the insulin. High blood levels of glucose can cause several
problems, including
frequent urination, excessive thirst, hunger, fatigue, weight loss,
and
blurry vision. However, because type 2 diabetes develops slowly,
some people with high
blood sugar experience no symptoms at all. Patients with type 1
diabetes usually develop symptoms
over a short period of time, and the condition is often diagnosed in
an emergency
setting.
Gynecomastia is the formation of abnormal breast tissue in males.
The condition may occur in one or both breasts and begins as a small
lump beneath the nipple, which may be tender. The breasts often
enlarge
unevenly. Apart from puberty, causes of gynecomastia include chronic
liver
disease, kidney failure, and exposure to estrogens, androgens (often
taken
secretly for body building), marijuana, and some medications. Rare
causes include tumors, genetic
defects, or an overactive thyroid.
Testicular Atrophy / Hypogonadism
Testicular atrophy is a term used to describe the shrinking of
testicles. Hypogonadism is a reduced or absent secretion of hormones
from the sex
glands (gonads). In men, these are the testes; in women, the
ovaries.
The cause of hypogonadism may be "primary" or "central." In primary
hypogonadism, the ovaries or testes themselves do not function
properly.
Some causes include surgery; radiation; genetic and developmental
disorders; liver and kidney disease; infection; and certain
autoimmune
disorders. In girls, hypogonadism during childhood will result in
lack of
menstruation and breast development and short height. If
hypogonadism occurs
after puberty, symptoms include loss of menstruation, low libido,
hot
flashes, and loss of body hair.In boys, hypogonadism in childhood
results in lack of muscle
and beard development and growth problems. In men the usual
complaints are sexual
dysfunction, decreased beard and body hair, breast enlargement, and
muscle loss.
Thyroid Disease
The thyroid gland is located in the base of the neck on both sides
of
the lower part of the larynx and upper part of the trachea.
The gland produces thyroid hormone in response to stimulation by a
hormone from the pituitary gland. Thyroid hormone acts throughout
the body
to regulate the metabolism of the cells.
Hyperthyroidism or thyrotoxicosis occurs when the thyroid releases
too
many of its hormones over a short (acute) or long (chronic) period
of
time. Many diseases and conditions can cause this problem.
Symptoms can include weight loss, increased appetite, nervousness,
restlessness, heat intolerance, increased sweating, fatigue,
frequent bowel
movements, menstrual irregularities and goiter (visibly enlarged
thyroid). Hypothyroidism, or under activity of the thyroid gland,
may cause a
variety of symptoms and may affect all body functions.
The body's normal rate of functioning slows, causing mental and
physical sluggishness. The symptoms may vary from mild to severe,
with the most severe form
called myxedema, which is a medical emergency.

Muscle and Bone Disorders
Arthralgia is pain affecting one or more joints. Arthralgia is
commonly associated with arthritis, discussed below.
Arthritis (Osteoarthritis and Rheumatoid Arthritis)
Arthritis involves inflammation of one or more joints and the
breakdown
of cartilage. Cartilage normally protects the joint, allowing for
smooth movement.
Cartilage also absorbs shock when pressure is placed on the joint.
Without the usual amount of cartilage, the bones rub together,
causing pain,
swelling, and stiffness. With some injuries and diseases, the
inflammation does not go away or
destruction results in long-term pain and deformity; this is called
chronic arthritis.
Osteoarthritis is a chronic disease causing deterioration of the
joint
cartilage (the softer parts of bones, which cushion their
connections
to each other) and the formation of new bone (bone spurs) at the
margins
of the joints. For most people, the cause of osteoarthritis is
unknown, but metabolic,
genetic, chemical, and mechanical factors play a role in its
development.
Rheumatoid arthritis is a chronic (long-term) inflammatory disease
that
primarily affects the joints and surrounding tissues, but can also
affect other organ systems. The cause of rheumatoid arthritis (RA)
is unknown. However, RA involves
an attack on the body by its own immune cells (see the section on
auto-immune diseases, above).

Fibromyalgia Syndrome
Fibromyalgia is a chronic pain illness which is characterized by
widespread musculoskeletal aches, pain and stiffness, soft tissue
tenderness,
general fatigue and sleep disturbances. The most prominent symptom
of fibromyalgia is pain,
commonly located in the neck, shoulders, back, and hips.
Unlike arthritis, the discomfort is not in the joints but in the
muscles and ligaments.
Hepatic osteodystrophy is a generic definition for the metabolic
bone
disease that may occur in individuals with chronic liver disease,
involving two distinct processes, osteoporosis (the loss of bony
tissue) and
osteomalacia (softening of the bones). Hepatic osteodystrophy is a
common complication among individuals with
long time lasting hepatic disease, particularly those with
cholestasis
(reduced or stopped bile flow).
Hepatitis C-Associated Osteosclerosis
Hepatitis C-associated osteosclerosis is a very rare disorder
characterized by a marked increase in bone mass.
Symptoms include diffuse but progressive bone pain, elevated serum
alkaline phosphatase (ALP) activity, and increased bone density.
Inflammatory Myositis and Myalgia
Myositis is an inflammation or swelling of the voluntary (skeletal)
muscles. Mylagia is another term for muscle pain.

Neurological Disorders
Leukoencephalopathy is the destruction of the myelin sheaths which
cover nerve fibers and promote the transmission of nerve impulses.
Patients with this leukoencephalopathy may present with a variety of
clinical findings ranging mild confusion to lethargy, dysarthria,
dysphasia, ataxia, spasticity, or progressive dementia.
Paresthesia / Peripheral Neuropathy
Paresthesia refers to a burning or prickling sensation that is
usually
felt in the hands, arms, legs, or feet, but can also occur in other
parts of the body. The sensation, which happens without warning, is
usually painless and
described as tingling or numbness, skin crawling, or itching.
Chronic paresthesia is often a symptom of an underlying neurological
disease or traumatic nerve damage. Paresthesia can be caused by
disorders affecting
the central nervous system, such as stroke and transient ischemic
attacks (mini-strokes),
multiple sclerosis, transverse myelitis, and encephalitis.
A tumor or vascular lesion pressed up against the brain or spinal
cord
can also cause paresthesia. Nerve entrapment syndromes, such as
carpal tunnel syndrome,
can damage peripheral nerves and cause paresthesia accompanied by
pain.
Peripheral neuropathy describes damage to the peripheral nerves.
It may be caused by diseases of the nerves or as the result of
systemic
illnesses. Many neuropathies have well-defined causes such as
diabetes, uremia, AIDs, or nutritional deficiencies.
In fact, diabetes is one of the most common causes of peripheral
neuropathy. Although the causes of peripheral neuropathy are
diverse, they produce
common symptoms including weakness, numbness, paresthesia (abnormal
sensations such as burning, tickling, pricking or tingling) and pain
in the arms, hands, legs and/or feet.
Encephalopathy
Encephalopathy is a term for any diffuse disease of the brain that
alters brain function or structure. Causes of encephalopathy
include infectious disease, metabolic
dysfunction, brain tumor, toxic exposure, chronic progressive
trauma, poor
nutrition, or lack of oxygen or blood flow to the brain, and more.
The hallmark of encephalopathy is an
altered mental state. Depending on the type and severity of
encephalopathy, common
neurological symptoms are progressive loss of memory and cognitive
ability,
subtle personality changes, inability to concentrate, lethargy, and
progressive loss of consciousness. Other neurological symptoms may
include involuntary twitching of a
muscle or group of muscles, rapid, involuntary eye movement, tremor,
muscle
atrophy and weakness, dementia, seizures, and loss of ability to
swallow or speak.
Skin Disorders
Acral Necrolytic Erythema
Necrolytic acral erythema is a rash located exclusively on the acral
areas (the extremities of peripheral body parts), and is strongly
association with hepatitis C infection. The rash appears as
erythematous (reddened) patches
with darkened borders, loose blisters with erosions.
Erythema Multiforme is a type of hypersensitivity (allergic)
reaction
that occurs in response to medications, infections, or illness.
Erythema multiforme may present with a classic skin lesion with or
without systemic (whole body) symptoms.
In Stevens-Johnson syndrome, the systemic symptoms are severe and
the
lesions are extensive, involving multiple body areas (especially the
mucous membranes). Toxic epidermal necrolysis (TEN syndrome, or
Lyell's syndrome)
involves multiple large blisters (bullae) that coalesce, followed by
sloughing
of all or most of the skin and mucous membranes.
Palmar Erythema
Palmar erythema is a reddening of the palms of the hands. Sometimes
the soles of the feet are often also affected. Also known as "liver
palms," palmar erythema
has been attributed to high estrogen levels.
Thrombocytopenic Purpura
is a bleeding disorder characterized by too few platelets in the
blood.
This is because platelets are being destroyed by the immune system.
The
disease occurs when immune system cells, called lymphocytes, produce
antibodies against platelets. When the cause is unknown, the
condition is called Idiopathic
Thrombocytopenic Purpura (ITP).Platelets are necessary for normal
blood clotting. They clump
together to plug small holes in damaged vessels. The presence of
antibodies on platelets leads to their
destruction in the spleen. A characteristic skin rash, easy
bruising, abnormal menstrual bleeding,
or sudden and severe loss of blood from the gastrointestinal tract
may occur.
Lichen Planus
Lichen planus is an uncommon disorder involving a recurrent, itchy,
inflammatory rash or lesion on the skin or in the mouth. The exact
cause
is unknown, but the disorder is likely to be related to an allergic
or
immune reaction.
The disorder has been known to develop after exposure to potential
allergens such as medications, dyes, and other chemical substances.
Symptoms are increased with emotional stress, possibly because of
changes in immune system during stress.
Symptoms include itching in the location of a lesion, skin lesions
located on the inner areas of the wrist, legs, torso, or genitals,
ridges
in the nails, dry mouth, metallic taste in the mouth, mouth lesions
and
hair loss.
Papular Acrodermatitis (Gianotti-Crosti disease)
Acrodermatitis is a skin condition peculiar to children that may be
accompanied by mild symptoms of fever and malaise.
It may also be associated with Hepatitis B and other viral
infections.
The mechanism that causes acrodermatitis is poorly understood, but
its
association with other infections is well documented.
The lesions of acrodermatitis appear as small coppery-red, flat-
topped
firm papules that appear in crops and sometimes in long linear
strings.
The lesions are often symmetric (equal on both sides) and appear on
the
face, arms and legs, and buttocks. This is one of the few rashes
that may also appear
on the palms and soles. Generalized enlargement of the lymph nodes
and liver may be seen.
In Italian children, acrodermatitis is seen frequently in
conjunction
with Hepatitis B, but this association is rarely seen in the USA.
In addition to Hepatitis B, acrodermatitis has also been associated
with Epstein-Barr virus infections (EBV, mononucleosis),
cytomegalovirus,
coxsackie viruses, parainfluenza virus, respiratory syncytial virus
(RSV), and some live virus vaccines.
Pruritus (Itching) and Urticaria (Skin Rash)
Pruritus is an itching sensation that triggers the desire to
scratch.
It is a distressing symptom that can cause discomfort.
Scratching may cause breaks in the skin that may result in
infection.
Pruritus can be related to anything from dry skin to undiagnosed
cancer.
Pruritus is a symptom, not a diagnosis or disease.
Rashes involve changes in the color or texture of skin. Often, the
cause of a rash can be determined from its visible characteristics
and
other symptoms. A simple rash is called dermatitis, meaning
inflammation of the skin.
Contact dermatitis is caused by things your skin touches, such as
dyes
and other chemicals in clothing, chemicals in elastic, latex, and
rubber products, cosmetics, soaps, detergents, poison ivy, oak, or
sumac.
Seborrheic dermatitis is a rash that appears in patches of redness
and
scaling around the eyebrows, eyelids, mouth, nose, the trunk, and
behind the ears. If it happens on your scalp, it is called dandruff
in adults and cradle
cap in infants. Many medical conditions can cause a rash, such as
lupus erythematosus,
rheumatoid arthritis, especially the juvenile type, and kawasaki
disease.
Vision Disorders
Mooren's Ulcer is a chronic superficial ulcer of the cornea with a
undermined border. It is progressive, painful, and may involve the
entire cornea of the
eye.